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Written by Shannon Fujimoto Nakaya, DVM

While the subject of Graceful Aging, Graceful Exits is our animal companions, I felt a section on caregiving to be a necessary reality check. In fact, I've also asked others to contribute to this section (see subpages) and share their experiences and wisdoms. Like parenting or human eldercare, caregiving comes more naturally to some than to others. For some, as much as they love an animal companion, there can be physical, emotional, and/or financial barriers to caregiving. Knowing our limitations is important and sometimes necessary in making decisions on behalf of our animal companions.

Dollar expenses of caregiving can be costly or relatively nominal, depending on the patient.

I used to wonder at people who chose not to travel so that they could be at home to care for a pet. But when I thought of leaving my older, sometimes confused, animal companion just so that I could travel somewhere exotic, I decided that Paris would be there next year and the year after, and made choices during the later years of my pet's life according to my priorities. In some situations, however, time away from home may not be an option: family obligations (child getting married or an ailing parent), work obligations, or medical care, for example. I still needed to attend conferences and seminars to stay on top of my profession. Fortunately, an equally committed human companion and a very trusted pet sitter could cover for me during those business trips.

Patients don't always require someone to be present 24/7, but when they do, caregiving can suddenly become a whole new challenge to employment, not to mention life. If the condition is chronic or ongoing, like paralysis or dementia, the caregivers may have to decide if a long term plan is even possible and how to make it work. In the later stages of my dog's life with dementia, he really couldn't be left alone. Fortunately, at that stage, both my significant other and I were self-employed and able to stagger our schedules so that one of us was always home. Fortunately also, I was able to scale back my practice for six months. And we were blessed with a trusted pet sitter who could give us a few hours of synchornized "time off" every week if we both needed to be somewhere at the same time, or just wanted to go on a lunch date together. It took commitment, team work, and dedication. Financially, we barely broke even that year, and were not able to contribute to either of our retirement accounts. Year after year, it would not have been sustainable and fiscally responsible. Nevertheless, I will always be grateful that I was able to fulfill the promise I made to my day-to-day canine partner and companion of 16-1/2 years, to be there to share in his periods of happiness and to help him through his periods of confusion, and to support his interest in living as long as life was good.

If there is a family group rather than an individual, then there is a better chance that a team of caregivers can be put together to share caregiving responsibility. It is also more likely that there will be some conflict about how much care to provide and when to stop. This is not to say that living independently means caring for an aging pet is not possible. People who live independently tend have fewer day-to-day family obligations; their down time is their own to spend how they want.

Unlike human eldercare, there is less community support for pet eldercare. It is not easy to find someone to help walk your dog at 3 am, or hand feed your cat every 4 hours, or give injections, change diapers, bathe, lift and carry, with the care and compassion deserved by a convalescing animal companion. Sadly, I have on numerous occasions witnessed paid caregivers (for both humans and animals) who go through the motions of providing care without the compassion of caregiving. For them, it is a job; not a gift that springs from care and compassion. The situation may become even more complex if it is a level of care that they might choose not to provide if it were their own pet. And most patients, whether or not they "say" anything, are very aware of how they are being treated; I see it in their expressions and their responses. There is a difference between gently guiding an older or handicapped patient to where they need to go, versus impatiently dragging them by a leash. There is a difference between someone warming up food and serving it to a patient versus just putting the dish of food on the floor. There is a difference between lifting and supporting a patient in an appropriate position to pee versus plopping them on the grass. Many times, senior patients need to urinate more often. Moreover, with less bladder control, when they need to go, they need to go NOW. When they require assistance to do this every 3 hours around the clock, it can admittedly become tiresome. Remember that as tedious a it can become for the caregiver, it is also tiresome for the patient. It is no one's fault; it is just the way it is. There is an art form to caregiving that honors the patient, and part of that art form is keeping an upbeat attitude and putting a positive spin on the patient's present physical realities – "at least it's coming out", "at least you have me", "keeps us both exercising", "if this pee were worth something, we'd be rich", "hey, I haven't seen you lift your leg in weeks!" Patients know when there is true love (I recognize that you have a need and I want you to be comfortable) driving an action and when it is just someone's job. There are modern day Florence Nightingale amazing caregivers out there; if you happen to land one of them, count your blessings and reward them well.